ATTESTATION OF ACTIVITIES*/FORMULAIRE DATTESTATION DACTIVITS

(REGULATION (EC) 561/2006 OR THE AETR) /(RGLEMENT (CE) 561/2006 OU LAETR)

POTVRDA O ODSUSTVOVANJU VOZAA
To be filled in by typing in Latin characters and signed before a journey / Popunjava se u tampanom obliku i potpisuje pre poetka putovanja
To be kept with the original control device records wherever they are required to be kept / uva se uz originalni tahografski listi ili ispis iz digitalnog
tahografa
False attestations constitute an infringement / Unos netanih podataka u potvrdu predstavlja prekraj
Part to be filled in by the undertaking / Popunjava prevoznik
1.

SZTKR I AP " DRUMS SPED"

Name of the undertaking / Naziv preduzea /preduzetnika

2.

Save Kovacevica 68a 21460 Vrbas

Street address, postal code, city / Ulica, potanski broj, grad ......
...........
Country / Drava: Republic of Serbia / Republika Srbija

21705880

3.

Telephone number (including international prefix) / Broj telefona

+381 ......

4.

Fax number (including international prefix / Broj faksa

+381 .

5.

Adresse courrier lectronique / adresa elektronske pote):.

I, the undersigned / Ja, dole potpisani:

21700584

DRAGAN VUJICIC

6.

Name and first name / Ime i prezime:

7.

DIREKTOR
Position in the undertaking / na radnom mestu u preduzeu ..

declare that the driver / izjavljujem da je voza:

KNEEVI BRANISLAV

8.

Name and first name / Ime i prezime vozaa..:...

9.

25.09.1987.
Date of birth (day/month/year) /Datum roenja: (dan/mesec/godina): ..

10.

Driving licence or identity card or passport number / Broj vozake dozvole line karte ili pasoa

br. pasosa 008762695

.
11.

who has started to work at the undertaking on (day/month/year) / koji je otpoeo sa radom u preduzeu (dan/mesec/godina)

01.03.2013.

au cours de la priode / za period:

08.h,00min.10.06.2013.

12.

from (hour/day/month/year) / od(as/dan/mesec/godina):

13.

08.h,25min.17.07.2013.
to (hour/day/month/year) / do (as/dan/mesec/godina):

14.

was on sick leave* / bio na bolovanju*

15.

was on annual leave* / koristio godinji odmor*

16.

was on leave or rest* / odsustvovao sa posla ili koristio slobodne dane*

17.

drove a vehicle exempted from the scope of Regulation (EC) 561/2006 or the AETR* / upravljao vozilom koje nije iz oblasti AETR-a*

18.

performed other work than driving* / obavljao druge poslove osim upravljanja vozilom*

19.
20.

was available / bio raspoloiv

*

17.07.2013.

Place / Mesto:.... Date / Datum:

Signature / Potpis:.

21.

I, the driver, confirm that I have not been driving a vehicle falling under the scope of Regulation (EC) 561/2006 or the AETR during the
period mentioned above / Ja, voza, potvrujem da nisam upravljao vozilom iz oblasti AETR-a tokom gorepomenutog perioda.

22.

Place / Mesto:. Date / datum.........................

17.07.2013.

Signature of the driver / Potpis vozaa:

...................................................................................................

Choose only one box/ Izabrati jednu od ponuenih opcija.